Danis J, Hubmann R, Pichler P, Shamiyeh A, Wayand W U
Second Department of Surgery, General Hospital and Ludwig Boltzmann Institute for Operative Laparoscopy, A 4020 Linz, Krankenhausstr. 9, Austria.
Surg Endosc. 2004 Apr;18(4):702-5. doi: 10.1007/s00464-003-9096-7. Epub 2004 Mar 19.
Liver cirrhosis leads frequently to the development of ascites and a formation of varicose veins in the esophagus. The latter presents increased mortality risk. Recently, significant progress in laparoscopic technology enabled devascularization of the proximal stomach in a less invasive way. The results experienced by five patients are presented.
Laparoscopic azygoportal disconnection was performed by means of novel technique (Danis procedure) in five men with esophagus varices bleeding (2nd to 11th events) and liver cirrhosis stage Child-Pugh B and C. This procedure was performed after all other methods had either failed to prevent recurrent bleeding or were refused by the patient. Five ports were positioned on the upper abdominal wall. The veins in the lesser omentum were divided by means of the LigaSure-Atlas device. The stomach coronary vein was visualized, and all the proximal branches toward the esophagus as well as the short gastric vessels were divided. The diaphragm hiatus was opened, and the distal esophagus was dissected. The paraesophageal venous collaterals also were divided, and the remaining varicose veins of the esophagus were interrupted by transmural stitching.
All the patients survived the minimally invasive procedure. Two of them died 9 and 16 months after surgery, respectively, because of liver insufficiency. No bleeding event from varicose veins in the esophagus occurred postoperatively.
Laparoscopic azygoportal disconnection is a less invasive method for prevention of rebleeding from varicose veins in the esophagus. Further studies are necessary to confirm these preliminary results.
肝硬化常导致腹水形成及食管静脉曲张。后者会增加死亡风险。近年来，腹腔镜技术取得显著进展，使得以微创方式对胃近端进行去血管化成为可能。本文介绍了5例患者的治疗结果。
对5例食管静脉曲张出血（第2至11次出血事件）且处于Child-Pugh B级和C级肝硬化阶段的男性患者，采用新技术（达尼斯手术）进行腹腔镜奇静脉门脉断流术。该手术在所有其他预防复发性出血的方法均失败或患者拒绝采用时进行。在上腹壁放置5个端口。借助LigaSure-Atlas设备切断小网膜内的静脉。显露胃冠状静脉，切断其所有向食管的近端分支以及胃短血管。打开膈裂孔，游离食管远端。切断食管旁静脉侧支，通过全层缝合阻断食管其余曲张静脉。
所有患者均在微创手术后存活。其中2例分别在术后9个月和16个月因肝功能不全死亡。术后未发生食管静脉曲张出血事件。
腹腔镜奇静脉门脉断流术是预防食管静脉曲张再出血的一种微创方法。需要进一步研究以证实这些初步结果。
